Stress, the malady of our times, increases our need for nutrients and, at the same time, depletes those we already have, says Peter Dingle PhD

Stress is a major health problem linked to most forms of chronic illness, from Alzheimer's and ADHD to cancer and cardiovascular disease. It is arguably one of the biggest killers, if not the biggest, in Western society. An estimated 75% to 90% of patients visiting the doctor name it as their primary issue (1) and recently I wrote on the role of stress in increasing the risk of heart attack and stroke. (See Stress: the Silent Killer December 2011 Vol 18 No 10)

Current research suggests that stress may play a significant role in increasing the body's requirement for a range of nutrients, such as vitamins A, C, E and B complex, as well as the minerals magnesium, potassium, zinc and calcium, and amino acids. It is likely that stress increases the body's requirements for almost all nutrients through an increase in cellular activity, as well as the demand for specific nutrients used in the stress response. In addition, there are many studies supporting the use of nutritional supplements in reducing the negative impacts of stress. So if you can't reduce your stress increase your supplement level.

Vitamin C is one of the first vitamins to be depleted by stress. Even more important is how we deal with vitamin C and stress compared to other animals. Plants readily produce vitamin C (C6H806) from the simple sugar, glucose. Humans, primates, the guinea pig, the red-vented bulbul, the Indian fruit-eating bat, rainbow trout and Coho salmon do not produce their own vitamin C. Most mammals utilise a four enzyme system in the liver that enables them to manufacture their own ascorbate (vitamin C). Humans have three enzymes in our liver but we're missing the fourth one, L-gulonolactone oxidase, thus blocking the production of ascorbic acid. This means that we can't produce vitamin C while most other animals do. They don't need to have it in their diet every day, but we do.

So an interesting question arises, what happens to the vitamin C in these animals when they get stressed? Essentially, the more stress, the more vitamin C they produce as shown in the table below. When stressed, rats and goats increase their production of vitamin C by three to seven times - in the tens of thousands of milligrams, which is significantly higher than the 60 or 120 milligrams the government recommends as an RDA/RDI, as shown in the table below. Nature knows how to deal with stress better than our governments do.

Research has found that stress, and stress-related depression, could result in a lowering of the immune system functioning, primarily the lymphocyte activity ("nt" activity) by up to 50% (2). This is likely to lead to an increase in infections in the short term and cancer in the long term. The most significant finding of this study, however, was that this diminished lymphocyte activity could be prevented to a large extent by a diet high in antioxidants. In a follow up study, researchers found that ascorbate (Vitamin C) inhibited the stress-related reduction of nt activity and was shown to reverse the effect (2).

Supplementation with vitamin C blunted the rise in blood pressure and anxiety in individuals experiencing acute psychological stress (3). Subjects in a study received two 500 milligram sustained release vitamin C capsules four times a day for 14 days, before being subjected to a stressful event - public speaking. Those subjects receiving the vitamin C exhibited significantly lower blood pressure just before the stress, and up to 40 minutes after, than individuals receiving a placebo. Feelings of stress and anxiety after the event were also significantly lower in the vitamin C group (3). Moreover, the report advised that the levels of vitamin C required to mediate the stress response were unlikely to come from diet alone, stressing the need, pardon the pun, for antioxidant supplementation among stressed individuals. A number of animal studies have also strongly suggested that ascorbic acid supplementation reduces stress induced cortisol release and other indices of stress including mortality, following exposure to a stressor (4,5,6).

Chronic stress results in a lowering of serum concentrations of the B vitamins, especially pantothenic acid (7), which can affect the ability of the adrenal glands to produce a range of essential hormones (7). Other B vitamins, such as vitamin B2 (riboflavin) and choline, may also be depleted through chronic stress, as they are used by the pituitary gland for the production of a range of hormones, which are released during the endocrine response to stress (7,8). As the vitamin B complex is synergistic, it is therefore of greatest benefit to the body when the entire complex is present. This is why most vitamin stress formulas include the whole B complex. The effect of B vitamin depletion on the body is further amplified because the B vitamins help the breakdown, absorption and utilisation of food in the stomach. So, an absence of sufficient levels of B vitamins may hinder the absorption and digestion of other essential nutrients, further impacting nutrition (9), leading to a vicious cycle of nutrient depletion in stressed people.

In humans, vitamin B5 serves to defend against a significant rise in the levels of cortisol in the body. One study's findings suggest that vitamin B5 will help to prevent hypersecretion of cortisol, the main stress hormone, from the adrenal glands (1,10). Other vitamins and supplements that benefit those suffering from adrenal fatigue include vitamins B1 and B12 (used by the endocrine (hormone) system), fish oils and "adaptogens." An adaptogen is a plant which, when taken as a supplement, must be harmless to the host, has a nonspecific effect on the host, serves as a bolster against stressors and serves as a stabiliser to various systems in the body (1). Myriad botanicals fall under this category, including panax ginseng or Korean ginseng (11), withania somnifera (ashwagandha), Ayurvedic herbs (1), and licorice, which is used to revive the production of cortisol after fatigue has occurred. Licorice, however, should be taken only at the beginning of treatment as it can raise blood pressure over time (11). In certain cases, these adaptogens have the effect of increasing the function of the stress response system if it is not responding sufficiently to stressors; and, if the adrenal glands are hyper-secreting cortisol, the adaptogens will help to reduce the production (1).

Almost all stress states produce an increased requirement for amino acids, the building blocks of proteins including enzymes that do all the work around the body and neurotransmitters. The key amino acids depleted by stress are lysine and tyrosine and, to a lesser extent, phenylalanine, cysteine and aspartic acid. Tyrosine is closely associated with stress, as it is required for the production of dopamine, noradrenaline and adrenaline (12) , three essential neurotransmitters to help with daily body functioning and particularly with relaxation and a sense of control. On a broader level, demand for amino acids increases in stressed individuals due to an overall increase in caloric needs, which occurs primarily as an increase in protein requirements.

Studies have shown the positive effects that lysine and arginine, two amino acids, have in reducing stress-induced anxiety and restraining body weight reduction in rats. Other studies have found that lysine and magnesium normalise ACTH (adrenocorticotropic hormone, which is produced in response to stress) and cortisol responses to acute psychosocial stress. In one study, male pigs underwent an experiment with some having a diet of increased lysine and arginine levels, while a control group had normal lysine levels fed to them. Pigs on the lysine and arginine diet had significantly lower plasma cortisol levels than the control; that is, they showed a lower stress response. The effect of lysine and arginine disappeared two days after the pigs were taken off the diet. Locomotion and behavioural stress was also recorded, with pigs on lysine and magnesium found to have symptoms significantly reduced (13). In another study, antioxidants, specifically the antioxidant glutathione, were effective in reducing the levels of stress-induced oxidative damage in rats (14).

Chronic stress depletes a number of minerals, including zinc (15), magnesium (16,17) and calcium. Calcium is profoundly depleted by stress due to calcium's role in impulse transmission in the nervous system (18,19); it helps carry messages around the nervous system. These effects are magnified by the fact that stress appears to decrease the absorption rates of calcium during digestion, as well as increasing overall calcium excretion rates (8,20). This is likely then to have long term implications for proper bone development and protection.

Studies have shown that vitamin E and selenium improve stress responses in other animals (21) and reduce serum concentration of cortisol, the main stress hormone (22). A similar study also showed that zinc supplementation produced an improved response (23). Supplementation with vitamin A may help adrenal function to prevent the over-production of cortisone (24). One study found that lowered magnesium levels were associated with a vasoconstriction in students experiencing chronic stress and sleep deprivation. Vasoconstriction is a major risk factor for heart attack and stroke.

Stress may also alter behaviour patterns that influence the nutritional status of individuals. These behavioural changes include an increase in smoking and alcohol consumption, a reduction in exercise, deregulation of the diet, loss of sleep and a decreased adherence to healthy regimes (25). Specific dietary changes may include increased consumption of nutrient-poor carbohydrate foods, saturated fat and salt, along with low fruit and vegetable consumption. We often turn to the high sugar and fat fast foods to satisfy our cravings during stress and certainly, stress and high workload periods are associated with higher energy and saturated fat and sugar intake (26,27). Further, strong emotional or motivational states can cause normally restrained eaters to overeat (27). Stressed emotional eaters ate more sweet high-fat foods and more energy-dense meals than unstressed and non-emotional eaters (27). Stress-driven eaters tended to eat sausages, hamburgers, pizza and chocolate more frequently than other people - and there's not much nutrition in these. Stress-driven eaters also consumed more alcohol than other people (27).

The consumption of "sympathomimetic" agents has been shown to increase markedly in conditions of acute and chronic stress. Sympathomimetic agents simulate the body's stress response through activation of the central nervous system, and include substances such as caffeine, alcohol, nicotine, food colouring and preservatives (18). These agents may also reduce the absorption of nutrients in the diet and increase their excretion from the body, setting up a vicious cycle of nutrient depletion.

In summary, if you are stressed you need to supplement and the more stressed you are, the more you need to supplement.